Dental Patient Health History Forms
Below are the dental forms and dental consent forms we use in easy to download and print format. Many of our patients prefer to fill these out at home and simply bring them to their appointment. We have found that this is less stressful and more streamlined for our patients and that it makes for a less hectic and more enjoyable dental visit.
If you are a new patient, please download and print the Health History forms, Insurance, Notice of Private Practice, Private Practice Acknowledgment forms listed below. Please go to our Contact Us page for a mailing address or Fax to the following numbers:
- Downtown: (816) 421-0356
- Independence: (816) 795-6732
- Plaza: (816) 531-0559
Please follow up your fax to confirm receipt of forms - thank youHealth History: docs/New patient form.docx
Insurance: docs/Update Insurance Form.pdf
Notice of Private Practice: docs/NOTICE OF PRIVACY PRACTICES-copy.pdf
Private Practice Acknowledgment: docs/Privacy Practice Acknowledgement-copy.pdf
Apply Today for Care Credit: www.carecredit.com
If you are transferring to another dental office, please download and print the Copy of Patient Record Request form below.
Copy of Patient Record Request: docs/Copy of Patient Records Request Form.xls